<style type="text/css" media="screen">

    .weui-cells__title{
        color:#000;
        font-size:17px;
    }
    .weui-cell::before{
      border-top:none;
    }
    .weui-cells::before{
      border-top:none;
    }
    .weui-cells::after{
        border-bottom: none;
    }
    .my-weui-cell{
        /* border-top: 1px solid #e5e5e5; */
        border-bottom: 1px solid #e5e5e5;
    }
    .inline-input {
        border: 1px solid #ccc;
        display:inline;
        width:150px;
    }

    .page__hd {
        /* padding: 0px; */
        padding: 0px 5px;
        padding-top: 10px;
        /* border: 1px solid #000; */
    }
    .page__title{
        margin-top: 5px;
        font-size: 20px;
        color: #333;
        text-align: center;
    }
</style>
<form name="form1" id="form1"  role="form" data-toggle="validator" method="POST" action="">

    <div class="page">

        <div class="page__hd">
            <div class="page__title">
                  {$title}
            </div>
            <!-- <div class="page__desc">
                  <span style="color: red">提醒：</span>为保证您和大家的健康安全，以下信息如有变动请及时更新！
            </div> -->
            <!-- <div class="page__desc">
                  <hr>
            </div> -->
        </div>
        <div class="page__bd">
            <div class="weui-cells weui-cells_form">
                <div class ="my-weui-cell">
                    <div class="weui-cells__title"><label class="weui-label">请选择类别</label></div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_group_id_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" data-role="student" name="group_id" value="1" id="r_group_id_1" tips="请选择类别">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">学生</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_group_id_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" data-role="teacher" name="group_id" value="2" id="r_group_id_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">教职工</div>
                        </label>
                        <!-- <label class="weui-cell weui-check__label" for="r_group_id_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" data-role="mechart" name="group_id" value="3" id="r_group_id_3">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">商户</div>
                        </label> -->
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title"><label class="weui-label">姓名</label></div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" required  name='row[nickname]' id='nickname' placeholder="请输入姓名" emptyTips="请输入姓名" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div id="student" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">学号</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                                <input class="weui-input" name='row[sid]' id='sid' type="tel" disabled   placeholder="请输入学号" emptyTips="请输入学号" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <!-- <div class ="my-weui-cell">
                        <div class="weui-cells__title">班级：</div>
                        <div class="weui-cell">
                            <div class="weui-cell__bd">
                                <input class="weui-input" name='row[classes_name]' id='classes_name' type="text" readonly
                                   placeholder="未获取到班级" emptyTips="未获取到班级" >
                                <input  type="hidden" id='year_' name='row[year_]' >
                                <input  type="hidden" id='classes_id' name='row[classes_id]'>
                                <input  type="hidden" id='college_id' name='row[college_id]' >
                                <input  type="hidden" id='classes_name' name='row[classes_name]' >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div> -->
                </div>
                <div class ="my-weui-cell" id="div_tel" style="display: none">
                    <div class="weui-cells__title" id="tel_lable">手机号或工号</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="tel" name='row[tel]' id='tel' required  placeholder="请填写" emptyTips="请填写" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">您当前所在地</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input city-picker" type="text" required  id='current_address' placeholder="请选择当前地址"  emptyTips="当前所在地" >
                            <input  type="hidden" required  id='province_code' name='row[province_code]' >
                            <input  type="hidden" required  id='province' name='row[province]' >
                            <input  type="hidden" required  id='city_code' name='row[city_code]' >
                            <input  type="hidden" required  id='city' name='row[city]' >
                            <input  type="hidden" required  id='district_code' name='row[district_code]' >
                            <input  type="hidden" required  id='district' name='row[district]' >

                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">1.你最近是否有下属情况？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a1_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_1]" value="1" id="r_a1_1" tips="请对第1题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">途径武汉</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a1_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="2" id="r_a1_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">途径湖北(除武汉)</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="3" id="r_a1_3">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">居住武汉</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_4">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="4" id="r_a1_4">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">居住湖北(除武汉)</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_5">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="5" id="r_a1_5">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">接触武汉籍人员</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_6">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="6" id="r_a1_6">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">接触湖北(除武汉)籍人员</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_7">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="7" id="r_a1_7">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">从外省返鲁</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="0" id="r_a1_0" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无上述情况</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div id="a_1" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">1.1. 如果您有上面的发生的事情,请填写时间:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_1_1]' id='a_1_1' type="text"  disabled placeholder="请填写日期" emptyTips="请填写日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">2.近期接触相关人员情况？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a2_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_2]" value="1" id="r_a2_1" tips="请对第2题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">接触确诊病例</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a2_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="2" id="r_a2_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">接触疑似病例</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a5_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_5]" value="3" id="r_a5_3">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">确诊病例</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a5_4">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_5]" value="4" id="r_a5_4">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">疑似病例</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a2_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="0" id="r_a2_0" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无上述情况</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div id="a_2" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">2.1. 如果您有上面的发生的事情,请填写时间:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_2_1]' id='a_2_1' type="text"  disabled placeholder="请填写日期" emptyTips="请填写日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">3.是否医学观察隔离？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a3_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_3]" value="1" id="r_a3_1" tips="请对第3题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">医院隔离</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a3_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_3]" value="2" id="r_a3_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">当地指定点隔离</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a3_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_3]" value="3" id="r_a3_3">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">居家隔离</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a3_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_3]" value="0" id="r_a3_0" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无上述情况</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div id="a_3" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">3.1. 如果存在医学观察隔离,请填写发生时间:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_5_1]' id='a_5_1' type="text"  disabled placeholder="请填写日期" emptyTips="请填写日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">3.2. 是否结束隔离？:</div>
                        <div class="weui-cells weui-cells_checkbox">
                         <label class="weui-cell weui-check__label" for="r_a3.2_1">
                            <div class="weui-cell__hd">
                                <input  type="radio" class="weui-check"  disabled name="row[a_3_2]" value="1" id="r_a3.2_1" tips="请对第3.2题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a3.2_2">
                            <div class="weui-cell__hd">
                                <input  type="radio"  class="weui-check" disabled name="row[a_3_2]" value="0" id="r_a3.2_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                    </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">4.你本人身体状况？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a4_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_4]" value="0" id="r_a4_0" tips="请对第4题做出选择" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">健康</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a4_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_4]" value="1" id="r_a4_1">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">咳嗽</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a4_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_4]" value="2" id="r_a4_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">发烧</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a4_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_4]" value="3" id="r_a4_3">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">呼吸困难等</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a4_4">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_4]" value="4" id="r_a4_4">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">确诊病例</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a4_5">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_4]" value="5" id="r_a4_5">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">疑似病例</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a4_6">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_4]" value="6" id="r_a4_6">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">其它</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell" id="a_4" style="display: none">
                    <div class="weui-cells__title">4.1. 状况说明:</div>
                    <div class="weui-cell">
                         <div class="weui-cell__bd">
                            <input class="weui-input " name='row[a_4_1]' id='a_4_1' type="text"  placeholder="请填写状况说明" emptyTips="请填写状况说明" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">5.家庭成员近况？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a5_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_5]" value="1" id="r_a5_1" tips="请对第5题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">接触确诊病例</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a5_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_5]" value="2" id="r_a5_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">接触疑似病例</div>
                        </label>

                        <label class="weui-cell weui-check__label" for="r_a5_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_5]" value="0" id="r_a5_0" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无上述情况</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div id="a_5" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">5.1. 如果您有上面的发生的事情,请填写时间:</div>
                        <div class="weui-cell">
                             <div class="weui-cell__bd">
                                <input class="weui-input datetime-picker" name='row[a_5_1]' id='a_5_1' type="text"  disabled placeholder="请填写日期" emptyTips="请填写日期" >
                            </div>
                            <div class="weui-cell__ft">
                                <i class="weui-icon-warn"></i>
                            </div>
                        </div>
                    </div>
                </div>
                <div id="teacher" style="display: none">
                    <div class ="my-weui-cell">
                        <div class="weui-cells__title">6.是否有返程计划？</div>
                        <div class="weui-cells weui-cells_checkbox">
                            <label class="weui-cell weui-check__label" for="r_a6_1">
                                <div class="weui-cell__hd">
                                    <input  type="radio" class="weui-check"  name="row[a_6]" value="1" id="r_a6_1" tips="请对第6题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">是</div>
                            </label>
                            <label class="weui-cell weui-check__label" for="r_a6_0">
                                <div class="weui-cell__hd">
                                    <input  type="radio" class="weui-check"  name="row[a_6]" value="0" id="r_a6_0">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">否</div>
                            </label>
                        </div>
                    </div>
                    <div id="a_6" style="display: none">
                        <div class ="my-weui-cell">
                            <div class="weui-cells__title">6.1. 返程方式:</div>
                            <div class="weui-cells weui-cells_checkbox">
                            <label class="weui-cell weui-check__label" for="r_a6.1_0">
                                <div class="weui-cell__hd">
                                    <input disabled type="radio" class="weui-check"  name="row[a_6_1]" value="0" id="r_a6.1_0" tips="请对第6.1题做出选择">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">自驾</div>
                            </label>
                            <label class="weui-cell weui-check__label" for="r_a6.1_1">
                                <div class="weui-cell__hd">
                                    <input disabled type="radio" class="weui-check"  name="row[a_6_1]" value="1" id="r_a6.1_1">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">火车</div>
                            </label>
                            <label class="weui-cell weui-check__label" for="r_a6.1_2">
                                <div class="weui-cell__hd">
                                    <input disabled type="radio" class="weui-check"  name="row[a_6_1]" value="2" id="r_a6.1_2">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">飞机</div>
                            </label>
                            <label class="weui-cell weui-check__label" for="r_a6.1_3">
                                <div class="weui-cell__hd">
                                    <input disabled type="radio" class="weui-check"  name="row[a_6_1]" value="3" id="r_a6.1_3">
                                    <i class="weui-icon-checked"></i>
                                </div>
                                <div class="weui-cell__bd">长途车</div>
                            </label>
                        </div>
                        </div>
                        <div id="a_6_1" style="display: none">
                            <div class ="my-weui-cell" >
                                <div class="weui-cells__title">6.2. 返程车次、机次:</div>
                                <div class="weui-cell">
                                     <div class="weui-cell__bd">
                                        <input class="weui-input"  name='row[a_6_2]' id='a_6_2' type="text"  disabled placeholder="请填写返程车次、机次" emptyTips="返程车次、机次" >
                                    </div>
                                    <div class="weui-cell__ft">
                                        <i class="weui-icon-warn"></i>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>

                <input type="hidden" name="row[lat]" id="lat" value="">
                <input type="hidden" name="row[lon]" id="lon" value="">

                <!-- <a href="javascript:;" id="datePickerBtn" class="weui-btn weui-btn_default">DatePicker</a> -->

            <div  style="margin-top: 15px;">
                <button id="formSubmitBtn" type="submit" class="weui-btn weui-btn_success">提交</button>
            </div>
        </div>
    </div>
</form>
<script type="text/javascript" charset="utf-8">
    wx.config({$wxjs});
    wx.ready(function () {
        wx.getLocation({
            type: 'wgs84', // 默认为wgs84的gps坐标，如果要返回直接给openLocation用的火星坐标，可传入'gcj02'
            success: function (res) {
                var latitude = res.latitude; // 纬度，浮点数，范围为90 ~ -90
                var longitude = res.longitude; // 经度，浮点数，范围为180 ~ -180。
                //var speed = res.speed; // 速度，以米/每秒计
                //var accuracy = res.accuracy; // 位置精度
                $("#lat").val(latitude);
                //$("#abc").val(latitude);
                $("#lon").val(longitude);
            },
            cancel: function (res) {
                alert('请允许获取位置');
                window.location.reload();
            }
        });
    })
</script>